CAMHS & Eating Disorders Flashcards
What is the 4P factor model in regards to child psychology?
Predisposing
Precipitating
Perpetuating
Protective
Takes a biopsychosocial approach
What types of ADHD are there?
Predominately inattentive (20-30%), predominately hyperactive-impulsive (15%) or combined type (50-75%)
How is ADHD diagnosed?
> 6 months inattention and/or hyperactivitity-impulsivity
Negative impact on academic, occupational or social functioning
Symptoms present in more than 1 setting i.e. home AND school
Not better explained by another disorder e.g. Autism, anxiety, FASD, ODD
Prevalence around 5% in children
In who does ADHD typically present?
Symptoms usually evident before age 12
M:F 3:1
Hyperactive-impulsive symptoms tend to recede, inattentive symptoms may persist
How is ADHD assessed?
Focused history, psychometrics e.g. Conners, school report, school obs to assess
ADHD focused group parent-training programme e.g. PINC is 1st line
Consider if school adjustments needed
Assess for comorbidities e.g. ASD, OCD, ODD, conduct disorder, anxiety
- 1 instruction at a time
- Brain breaks
- Don’t restrict fidgeting if not detrimental
What medication can be used for ADHD?
If medication required, must monitor height, weight, BP, HR, check for personal or family history of sudden cardiac events or breathlessness/fatigue/syncope on exertion
1) Methylphenidate 1st line (immediate or prolonged release)
2) Lisdexamphetamine 2nd line
3) Atomoxetine or guanfacine 3rd line (non-stimulants)
What triad of symptoms is present in autism spectrum disorder?
Impairments in reciprocal social interactions
Difficulties with social communication
Restricted, repetitive and inflexible patterns of interest or behaviour
When does onset of Autism spectrum disorder typically present and how?
Onset usually during early childhood, but may not become apparent until later
Deficits cause impairment in functioning
Evident across settings
Individuals may or may not have disorders of intellectual development or impaired functional language
Prevalence 1-2% of children, M:F approx. 4:1
How is autism spectrum disorder assessed and managed?
Higher incidence of sleep disorders, ADHD, anxiety, depression OCD and tics
Developmental history is cornerstone, can use structured interview e.g. ADI-R or 3Di, MDT assessment ideal to assess strengths and weaknesses
If further assessment required – ADOS, school reports and questionnaires, school observation
Parent-mediated intervention programme offered to all e.g. Cygnet
Behavioural interventions or environmental adjustments
Support for communication e.g. PECS, visual supports
Melatonin for sleep disorders, Aripiprazole or Risperidone for irritability or aggression
How are anxiety disorders assessed and managed?
Clinical history and examination, parent and school report
Can use psychometrics such as RCADS, C-YBOCS
Psychoeducation (directed to child or parent as appropriate)
Schools based intervention frequently
CBT, Graded exposure, Exposure response prevention, SLT, OT, Physio as appropriate
SSRI can be considered if inadequate response
Conduct disorders such as oppositional defiant disorder and conduct dissocial disorder are the most common mental & behavioural disorder in children: How do they present?
Increased risk in:
- Lower social classes
- LAAC
- Children who have been abused
- Children on the child protection register
> 6 months duration
ODD commoner in those age 10 and under, CD usually in those 11 and over
M>F
Significant comorbidity with ADHD
50% of those with conduct disorder go on to develop Antisocial PD: What is this associated with?
Associated with later:
- Poor educational attainment
- Social isolation
- Substance misuse
- Criminality
Assessed through clinical history from parents, observation of child, school report, psychometrics
Management – parenting programmes and multisystemic approaches via Social Work
How does ODD present compared to CD?
ODD:
- Markedly defiant, disobedient, provocative or spiteful behaviour
- Persistent angry/irritable mood, severe temper outbursts
- Argumentative/defiant behaviour
- Causes significant impairment in functioning
CD:
- Persistent violation of basic rights of others or major societal norms
- Aggression towards people, animals or property
- Deceitfulness, theft
- Serious violation of rules or laws
- Significant impairment in functioning
What is included in a MSE?
A= Appearance and behavior
S= Speech
E= Emotions (objective & subjective)
P= Perceptions
T= Thoughts (thought form and thought content)
I= Insight
C= Cognition
Risk – deteriation in ms, risks of neglect, vulnerability etc
What are risk factors for acute psychosis?
- Presents in late adolescence-early adulthood
- M>F
- Positive family history of psychotic illness common
Risk of developing psychosis is higher:
- ID and ASD population
- Urban environment, low SES, migrant or refugee
- Childhood adversity
- ?all are exposure to chronic social stress
- An acute stressor, poor sleep and illicit drug use can sometimes be identified as the acute trigger
